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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409384
Report Date: 05/20/2022
Date Signed: 05/20/2022 01:34:56 PM


Document Has Been Signed on 05/20/2022 01:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SANTANA FAMILY CHILD CAREFACILITY NUMBER:
197409384
ADMINISTRATOR:SANTANA, MARTA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 367-5632
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: 5DATE:
05/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Maria BecerraTIME COMPLETED:
01:49 PM
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On 05/20/22 Licensing Program Analysts (LPA's) Justin Dorsey conducted an Inspection at Santana FCC. The purpose of the inspection was a Plan of Correction to review the deficiencies cited on 04/26/22. LPA Dorsey met with licensee Assistant Maria Becerra and toured the facility. The following was observed:

1.) LPA observed care has been moved from the converted patio to the homes living room and dining room area.

Exit interview conducted a copy of this report, Notice of Site Inspection and Deficiency Clearance Letter was left with Assistant Maria Becerra. Report was read to licensees daughter over the phone.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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